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Critical Care |

Noninvasive Positive Pressure Ventilation (NIPPV) for Acute Hypoxic Respiratory Failure in Patients With Interstitial Pneumonia

Daisuke Takekoshi, MD; Seiichi Kobayashi, MD; Masaru Yanai, MD
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Tohoku University Hospital, Sendai, Japan


Chest. 2015;148(4_MeetingAbstracts):306A. doi:10.1378/chest.2269540
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Abstract

SESSION TITLE: Mechanical Ventilation and Respiratory Failure Posters

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 28, 2015 at 01:30 PM - 02:30 PM

PURPOSE: To evaluate feasibility of NIPPV in patients with interstitial pneumonia who presented with acute hypoxic respiratory failure.

METHODS: The study was conducted at a major community hospital in a middle-sized city in north-east area of Japan with population of approximately 140,000. We performed a chart review to identify patients with interstitial pneumonia who presented with acute hypoxic respiratory failure and NIPPV was applied over period from 2010 to 2012. We compared clinical characteristics of the two groups of patients, ones who were successfully liberated from NIPPV and the others who failed NIPPV (i.e., death or advancement to endotracheal intubation). Multiple clinical parameters were examined, including age, sex, history of smoking, past medical history, DNR status, duration of illness before presentation, vital signs, arterial blood gas analysis, laboratory parameters, and general impression of severity of illness on imaging, initial NIPPV setting, and interventions.

RESULTS: We identified 28 patients who meet the inclusion criteria. Primary diagnoses for acute respiratory failure were acute exacerbation of underlying idiopathic interstitial pneumonia (n=12, 43%), acute interstitial pneumonia (n=7, 25%), infectious pneumonia (n=4, 14%), ARDS (n=3, 11%), ANCA-related vasculitis (n=1, 4%), and other interstitial lund disease (n=1, 4%). Sixteen of them (57%) were successfully liberated from NIPPV. We found successful group required lower expiratory positive airway pressure (median 4cmH2O vs. 6cmH2O, p=0.002) with statistical significance and a trend of lower inspiratory positive airway pressure (6.5cmH2O vs. 9cmH2O, p=0.058) and tends to demonstrate higher initial PaO2/FiO2 ratio (150.7mmHg vs. 118.3mmHg, p=0.09).

CONCLUSIONS: Substantial fraction of patients with interstitial pneumonia who presented with acute hypoxic respiratory failure was successfully managed with NIPPV. Patients who were successfully managed with NIPPV tends to required lower setting of NIPPV and showed higher PaO2/FiO2 ratio, indicating they probably had less severe illness.

CLINICAL IMPLICATIONS: Use of NIPPV on patients with interstitial pneumonia who presented with acute hypoxic respiratory failure is controversial. However, our data suggests NIPPV be a reasonable treatment option with success rate of more than 50%, especially in patients with less sevre illness.

DISCLOSURE: The following authors have nothing to disclose: Daisuke Takekoshi, Seiichi Kobayashi, Masaru Yanai

No Product/Research Disclosure Information


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